Abstract/Details

Reimbursement comes from the heart: The organizational structure of emotions and care-work in nursing homes


2009 2009

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Abstract (summary)

This dissertation is a comparative, ethnographic study of emotion-work in two nursing homes – one part of a large, for-profit chain, the other part of a small, non-profit chain – and examines how nursing care-workers grapple with tensions between meeting organizational demands in an increasingly market driven field and providing compassionate care in times of personal crisis. Based on eighteen-months of fieldwork, sixty-five in-depth interviews and analysis of company documents, my research connects the financial and regulatory structure of long-term care to the emotional lives of staff in both nursing homes. While scholars have analyzed the consequences of medical reimbursement regimes on health care systems, my research uncovers the processes by which those consequences are created, and shows how their effects on residents are mediated through staff. Chapters 2-4 examine how proprietary status shaped the experience of work. Many scholars argue that for-profit facilities and non-profit facilities have become isomorphic since the imposition of market forces on long-term care. Although there were similarities between the two nursing homes, they were also strikingly different in their approach to reimbursement. While the for-profit won corporate awards for deftly maneuvering through the market, the non-profit’s community-oriented mission left them with a half-million dollar budget deficit. This section shows the processes by which market forces discipline community-oriented health services organizations such as nursing homes. Given this context, chapters 5-8 turn to how the staff used emotional attachments with residents to give their work dignity and meaning. Contrary to the established view that emotion work alienates employees, I argue that nursing care-workers used emotions – their own, their residents, and their colleagues – as resources in novel ways, even as their emotions were shaped and constrained by the financial and regulatory structure of long-term care. Emotions were shaped by organizations but they were not simply imposed on workers. Nursing care-workers themselves produced emotions, sometimes in ways consistent with organizational goals, and sometimes not, but they consistently found in their emotions a set of resources to manage the strains of their work lives.

Indexing (details)


Subject
Gerontology;
Organizational behavior
Classification
0351: Gerontology
0703: Organizational behavior
Identifier / keyword
Social sciences; Care-work; Emotions; Identity; Nursing-homes; Organizations
Title
Reimbursement comes from the heart: The organizational structure of emotions and care-work in nursing homes
Author
Rodriquez, Jason
Number of pages
268
Publication year
2009
Degree date
2009
School code
0118
Source
DAI-A 70/12, Dissertation Abstracts International
Place of publication
Ann Arbor
Country of publication
United States
ISBN
9781109500844
Advisor
Zussman, Robert
Committee member
Gerstel, Naomi; Jacelon, Cynthia; Tomaskovic-Devey, Donald
University/institution
University of Massachusetts Amherst
Department
Sociology
University location
United States -- Massachusetts
Degree
Ph.D.
Source type
Dissertations & Theses
Language
English
Document type
Dissertation/Thesis
Dissertation/thesis number
3380010
ProQuest document ID
304924711
Copyright
Database copyright ProQuest LLC; ProQuest does not claim copyright in the individual underlying works.
Document URL
http://search.proquest.com/docview/304924711
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